What is chondromalacia patellae?
Chondromalacia patellae, also known as chondromalacia patellae and chondromalacia patellae, is one of the common causes of anterior knee pain. It is a degenerative disease caused by damage to the cartilage surface of the patella and the articular cartilage of the patellar surface of the femur. It is characterized by knee discomfort, pain behind the patella, vague pain in the medial side of the knee, increased pain when moving, followed by a feeling of friction between the patella and pressure pain in the patella.
What are the causes of chondromalacia patellae?
Chondromalacia patella is an osteoarthrosis of the patellofemoral joint caused by chronic injury to the cartilage surface of the patella, resulting in swelling, cracking, breaking, erosion and loss of cartilage, and finally the same pathological changes occur in the cartilage of the femoral condyle opposite to it.
1, congenital abnormal patellar development.
2, long-term wear and tear of the knee joint, is the common cause of this disease.
3, abnormalities in the synovial fluid composition of the joint due to various causes.
Main symptoms.
1, young athletes are common, the initial pain under the patella, relieved after a little activity, and aggravated after too much exercise, gradually disappeared after rest.
2, pressure pain at the edge of the patella, squeezing or pushing the patella in the extended knee position can have a sense of friction, accompanied by pain. When patellofemoral joint osteoarthrosis is formed at a later stage, synovitis and joint effusion may occur. If the disease is of long duration, quadriceps atrophy may occur. The diagnosis of chondromalacia patella is mainly based on post-patellar pain, which is caused by the patellar compression and grinding test and the single-leg squat test. Attention should be paid to check for combined meniscal injury and traumatic arthritis.
X-ray examination: frontal, lateral and tangential x-ray of the knee joint, no abnormalities in the early stage, but in the late stage, the gap between the patella and femoral condyle may be narrowed due to extensive cartilage wear, and there may be osteophytes at the edge of the patella and femoral condyle.
Treatment: Non-surgical treatment: braking, physiotherapy, anti-inflammatory, patellar chondromalacia patch, joint cavity closure, etc. If strict non-surgical treatment is ineffective or there is congenital deformity, surgical treatment is feasible.
Why does chondromalacia patella occur?
1, congenital patellar developmental disorder, abnormal position and femoral condyles large and small abnormalities, acquired knee joint internal and external rotation deformity, etc., can make the patella unstable, in the process of sliding patellofemoral joint surface compressive stress concentrated in a certain point, become the basis of chronic injury.
2, long-term, forceful, rapid flexion and extension of the knee joint, increasing the wear and tear of the patellofemoral joint, such as the training of cyclists and skaters, is a common cause of this disease.
3, the patellar cartilage nutrition mainly from the synovial fluid, various causes of synovial fluid composition abnormalities, can make the patellar cartilage malnutrition, vulnerable to minor injuries and degenerative degeneration patellar chondromalacia what clinical manifestations, symptoms and signs?
Clinical manifestations.
Direct trauma to the knee can cause fracture of the patellar cartilage or osteochondral bone, or due to multiple injuries, such as sports injuries, causing degenerative changes to the cartilage, roughness of the cartilage surface, loss of luster, severe cases of cartilage loss, bone exposure, and its relative femoral articular surface is also damaged. The injury site is mostly in the center of the patella. The main symptom is post-patellar pain in the knee joint, which varies in severity, and is generally not apparent when walking on level ground, but increases after squatting, going up and down stairs, going up and down slopes, or walking long distances.
Signs and symptoms.
1, more common in young athletes. Initially, the pain under the patella is obvious at the beginning of training, relieved by a little activity, aggravated by prolonged training and gradually disappears after rest, with the prolongation of the disease, the pain lasts longer than the relief, resulting in the inability to squat, difficulty in going up and down the ladder or sudden weakness and fall.
2, patella edge pressure pain. When the patella is squeezed or pushed in the extended knee position, there is a feeling of friction and pain, and when the patellar cartilage is damaged, there is no joint effusion. If the disease is long, there is quadriceps muscle atrophy.
Diagnosis and examination.
1, X-ray film early no abnormal, late stage can be seen patellar semicircular bone superfluity affect patellofemoral joint surface is not smooth or gap narrowing, X-ray film can still find part of the cause, such as small patella, high patella or femoral epicondyle low level deformity.
2, radionuclide bone imaging examination, lateral position shows the patella limited radioactive concentration, has early diagnostic significance.
3, arthroscopy (can be performed at the same time some treatment, but expensive, about 3000 yuan) arthroscopy is the most valuable method to confirm the diagnosis of chondromalacia patellae. It can clarify whether there is a lesion in the articular cartilage and the extent of involvement, and the degree of patellar chondromalacia, and can better differentiate it from diseases characterized by anterior knee pain, especially in difficult patients.
4, Magnetic resonance imaging (MRI), also has early diagnostic significance.
Treatment options.
Non-surgical treatment.
1, After the appearance of symptoms, first brake the knee joint for 1-2 weeks, while performing resistance exercises for the quadriceps muscle to increase knee stability.
2. When swelling and pain suddenly increase, cold compresses should be applied, and after 48 hours, wet heat and physical therapy should be used instead.
3.Anti-inflammatory drug “Aminoglycoside” contains glucosamine, which helps synthesis of protein mucopolysaccharide in cartilage. 0.2-0.4g orally, twice daily, can not only relieve pain, but also help cartilage repair.
4, intra-articular injection of sodium vitreous acid (sodium hyaluronate) can regulate the viscosity and lubrication of joint fluid, protect joint cartilage, promote the healing and regeneration of joint cartilage, relieve pain and increase joint mobility. Usually 2ml is injected once a week for 4-5 times as a course of treatment.
5, intra-articular injection of prednisolone acetate can relieve symptoms, but it should be used with caution because it inhibits the synthesis of glycoprotein and collagen, which is detrimental to cartilage repair.
6.Strictly non-manipulative treatment is ineffective, or those with congenital deformity can be treated surgically.
Surgical purposes.
1, increase the stability of the patellofemoral joint in the course of activity, such as lateral joint capsule release, femoral epicondyle pad elevation, etc.
2, scrape away the smaller erosion lesions on the patellofemoral articular cartilage to promote repair.
3, patellofemoral articular cartilage has been completely destroyed, useful patellar resection method to reduce the development of patellofemoral joint osteoarthropathy, but the postoperative knee joint is obviously weak, it is difficult to continue its sports career.
Daily attention.
1, move the joint before exercise
Fully moving the joint before exercise can make all parts of the patellofemoral joint surface stimulated, and the synovial fluid nutrients can evenly penetrate into the cartilage tissue to enhance the lubrication of the joint.
2, avoid strenuous exercise
Avoid continuous squatting and strenuous exercise, such as climbing mountains, stairs and other knee flexion exercise. Avoid sudden changes in the intensity of exercise, and activities to increase strength and endurance should be gradual and increase gradually.
3. Maintain proper body weight
Appropriate weight can reduce the gravitational force on the knee joint, while obesity will increase the risk of degenerative diseases of the knee joint, forming a vicious circle, the greater the weight, the heavier the pain; conversely, the lighter the weight, the lighter the pain.
4.Supplement cartilage nutrition
Eat more food containing vitamins and proteins, such as fruits, vegetables, meat, seafood, etc.
5.Pay attention to keep warm and cold
During the cold season, keep the joints warm to prevent wind and cold invasion.
6, timely treatment
When there is discomfort or unlocalized pain in the knee joint, consider the possibility of early chondromalacia patellae, and take timely rest and timely treatment to prevent aggravation of joint cartilage degeneration.
Chondromalacia patella prevention.
1, avoid long-term, forceful, rapid flexion and extension movements.
The occurrence of chondromalacia patella has intrinsic and extrinsic factors for middle-aged and elderly people. The intrinsic factor is the degeneration of the articular cartilage itself, which is related to age and other factors. The extrinsic factor is the chronic damage to the articular cartilage caused by mechanical factors. Prevention of chondromalacia patellae is mainly from reducing the continuous pressure on the patellofemoral joint and improving the nutrition of the cartilage.
2, take the initiative to fully move the joint. To be carried out under non-weight-bearing conditions. Such as lying flat on the bed active extension and flexion of the knee joint. Insist on 10 minutes once a day in the morning and once in the evening. Adequate movement of the joint can make all parts of the patellofemoral joint surface are stimulated, synovial fluid nutrients can evenly penetrate into the cartilage tissue, and can enhance the lubrication of the joint.
3, to prevent continuous pressure on the patellofemoral articular surface. The patella is under greater pressure in the flexed knee position, which can easily damage the joint surface. To avoid continuous squatting pressure on the patellofemoral articular surface.
4, cast fixation or lower limb traction treatment. When the quadriceps muscle is contracted, it can drive the patella up and down, which is conducive to the nutritional penetration of the cartilage and reduces the continuous pressure on the patellofemoral articular surface.
5, when the knee joint discomfort or non-localized pain. To consider the possibility of early patellar chondromalacia, timely rest and timely treatment to prevent aggravation of articular cartilage degeneration.